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General NPI Number Information
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NPI Number | 1891132817
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Entity Type | Individual
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Provider Name | CANDICE STAPLETON PURVIS PA-C
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Gender | Female
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Dates
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Enumeration Date | 05/30/2013
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Last Update Date | 05/20/2019
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Provider Practice Location Address
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Address Line | 303 HARRIS INDUSTRIAL BLVD STE 3
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City | VIDALIA
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State | GA
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Zip | 30474-8854
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Country | US
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Telephone | 912-537-9355
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Fax |
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Provider Business Mailing Address
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Address Line | 303 HARRIS INDUSTRIAL BLVD STE 3
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City | VIDALIA
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State | GA
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Zip | 30474-8854
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 006802
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License Number State | GA
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